Cross-infection and Non-sociomial Infection

Question 1

Why are patients more susceptible to infection?

Answer 1

• Immunocompromised
• Administration of broad spectrum antibiotics (e.g. increased risk of C.diff)
• Barrier compromise

Question 2

What are the most common causes of Hospital associated infections?

Answer 2

• Catheter associated infection
• Infections associated with IV access use
• Ventilator associated Pneumonia
• Surgical site infection

Question 3

What organisms are most likely to cause infections through IV access?

Answer 3

• Staph Aureus (including MRSA)
• Staph Epidermis
• Candida
• Enterococci

Patients are switched to oral antibiotics as soon as possible

• Treatments include removal/exchange of IV device when clinically appropriate

Question 4

What organisms are likely to cause ventilator associated pneumonia?

Answer 4

• Pseudomonas Auroginosa
• Enterobacteriacease
• Staph Aureus

Question 5

What factors make Ventilator associated pneumonia a likely diagnosis?

Answer 5

• New/persistent infiltrates on CXR AND:

2 or more of:

• Purulent sputum
• Leucocytosis
• Leucopenia
• Temp > 38.3

Question 6

What organisms are most likely to cause infection through the surgical site?

Answer 6

• Staph Aureus
• Strep Pyrogenes
• Enterobacteriacease

Question 7

What is the management of MRSA?

Answer 7

MEDICAL:

• Vancomycin or Teicoplanin if strain not resistant to them
• In cases of resistance, use Linezolid or Doptomycin

CONSERVATIVE:

• Isolation
• Barrier nursing

Question 8

How does Clostridium Difficile present?

Answer 8

• Abdominal pain
• Watery diarrhoea
• Ileus
• Toxic megacolon

Question 9

How is Clostridium Difficile diagnosis?

Answer 9

Immunoassay for glutamate dehydrogenase

• Detection of toxin AND antigen

Question 10

How is Clostridium Difficile infection managed?

Answer 10

S - Suspect
I - Isolate within 2 hours
G - Gloves and apron
H - Hand wash and soap
T - Test immediately 

MEDICAL MANAGEMENT:

=> Mild/moderate:
- PO Metronidazole

=> Severe or not responding to Metronidazole:
- PO Vancomycin

=> Life threatening:
- PO Vancomycin + IV Metronidazole

Question 11

How are surgical site infections prevented?

Answer 11

=> Prevention methods:

• Hand hygiene
• Strict asepsis
• MRSA screening
• Hair removal
• Peri operative normothermia
• Minimally distributed low adherence/transparent dressing